11-0152 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA 'QUINTA, CALIFORNIA 92253
Application Number: �l1 00000152----
Property
0000152------Property Address: 53700 AVENIDA VALLEJO
APN: 774-123-011-14 -000000-
Application description: PLUMBING
Property Zoning: COVERESIDENTIAL
Application valuation: 700
Applicant:
w, ek
Architect or Engineer'
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with .
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C36 se No.: 880103
n
Date:: _1�-i1 fContrator:
' OWNER -BUILDER DEC ATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the
following reason ISec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish; or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale ISec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. .If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). .
( 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/11/11
-
Owner:
KOJIMA YOSHOKO
53700 AVENIDA VALLEJ0
LA QUINTA, CA 92253
(760) 564-3538
Contractor:
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ALVAREZ,
JORGE A.
D
C)
UJ
P.O. BOX
'984
Z
"
THERMAL,
CA 92274
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D
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(760)777-3613
0
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Lic. No.:
880103
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DI
------=-------- - - - - --- - -------- - - - - -—
WORKER'S COMP RATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
• for by Section 3700 of the Labor Code, for the performance. of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number . EXEMPT
_ .I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
• and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the La erl all forthwit with those provisions.
—Date:7__i I-�.fApplicant '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWF , AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application. '
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above -men iononed-prvpert for inspection pipes
—Date:2-t.�-�=1 Signature -(Applicant-or-Agent)T % C
Application Number
. . . . . 11-00000152
Permit
PLUMBING
Additional desc .
Permit'Fee . . .
. 22.50
Plan Check
Fee
5.63
Issue Date
Valuation
0
Expiration Date
8/10/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50 .
Special Notes and
Comments
`. REPLACE 50 GALLON
WATER HEATER.
Other Fees .. . .
. . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged
Paid. Credited
Due
Permit Fee Total
22.50
.00
.00
22.50
Plan Check Total
5.63
.00
.00
5.63"
Other Fee Total
1.00
.00
.00
1.00•
Grand Total
..29.13
.00
.00
29.13
LQPERMff
Prescriptive Certificate of Com fiance: Residential CF -IR -ALT
Residential Alterations Page 1 of 5
Project Name;—ate Zone i� #T tories
General Information
Site Address: —c� - V _
Enforcement Agency:q,_ :. Dater
Building Type �<ingle Family ❑. Multi Family
Circle the Front Orientation: N, E, S, W, or degrees
Conditioned Floor Area (CFA):
Project Type: ❑ Alterations ❑ Envelope ❑ Fenestrati n ❑ Roof ❑ HVAC
Table
Replacement or Change Out ❑ Duct Replacement Water Heater
NO This form is not to be used for Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces (for Furring :use the Mass and Furring Strips Construction table below)
Assembly Alteration
❑ Opening of framed cavity alone— Alterations that involve the opening of the framed cavity of a wall, ceiling, or floor.must install the
mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H.
❑ Replacement of entire assembly— Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A —J.
Opaque Surface DetaffS For the furred portioned of Mass Walls see Furring Strips Construction Table below.
A B C D
E
F G H I J
Proposed See °t`
Standard
Values From JA4
Table
Comment
Mass
Thickness'
Framing
Thickness,
Framed Continuous
JA4
Proposed
Tag/
IDS
Assembly Name
or Type'
Material
and Size
Spacing,
or Other'
U-
factor°
JA4 Table Cavity Insulation
Numbers R -values R -Value?
Assembly
Cell Values
Assembly.
U-factor9
Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and
Furring Consu-ttction table below.
1. For Tag/ID indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc... Indicate the Frame type and Size: For
Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 "or 24 "OC; or Other for all other assembly description
such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone; enter, the Standard Ufactor from Table 151-B, C or D for each different assembly Name or type.
5. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ".
7. Enter the Continuous insulation R -value for the proposed assembly; otherwise, enter " 0 ".
8. Enter the row and column of the Ufactor value based on Column F Table Number and enter the Assembly Ufactor in Column J
9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Onl
A I B I C I D I E
F I G H i J K
L
M
Proposed Properties of Masonry and Concrete
Walls From Reference
Joint Appendix Table 4.3.5 4.3.6 4.3.7
Added Interior or Exterior insulation
in Furring Space from Reference
Joint Appendix Table 4.3.13
Final
Assembby
Ufactor
Comment
Mass
Thickness'
Assembly
Name or
T eZ
_
U
N
JA4 Table 2
Number' ¢ >
N N
0
c 0 —
2 y E
W°
c a
E � E � � � „ �
Q >
Registration Number: Registration DateMme: HERS Provider:
2008 Residential Compliance Forms
liquil 2009
i
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 4 of 5
Project Name: Climate Zone # q of Stories
S6 imo,
1S 1
HVAC SYSTEMS - HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronie space heating.
Minimum
Duct or Piping
Configuration
Heating Equipment
Efficiency
Distribution Insulation Thermostat
(Central, Split,
Type and Capacity
AFUE or HSPF
Type and Location R -Value Typi
, S ace, Package or H dronic
Distribution Type
Number In
Tank
Energy Factor or
Insulation
Type'
Standar�ecirculatin )'
System
1. Indicate Heating Type (Central Furnace, Wall Furnace, Heal pump, Boiler, Electric Resistance, etc.)
2. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity
< 2 KIV or 7,000 Btidhr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §151(6)3 exception.
3. Refer to the HERS b'erification section on Page 4 of the CF -I R -ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts, Hydronie in Floor, Radiators, etc.)
HVAC SYSTEMS - COOLING
"O
, l02
Minimum
Efficiency
Duct or Piping Configuration
Cooling Equipment
(SEER/EER or Distribution
insulation Thermostat (Central, Split,
Type and Capacity 1'2
COP) Type and Location
R -Value Type Space, Package or H dronic)
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements o 150(j .
1. Indicate Cooling Type WC, Heal pump, Evap. Cooling, etc)
1. Refer to the HERS Verification section on Page 4 of the CF -/R -ALT Form for additional requirements and check applicable boxes.
3. Indicate Type or Location (Ducts, H dronic in Floor, Radiators, etc.
WATER HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronie space heating.
Individual dwelling DHW heaters must ba
gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground
hot water pipes is required in all omponent packages in all climate sones.
External Tank
Water Heater Type/Fuel
Distribution Type
Number In
Tank
Energy Factor or
Insulation
Type'
Standar�ecirculatin )'
System
C aci (al)
Thermal Efficient
R-Value3
"O
, l02
2
.9,
1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.)
2. Reeirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n).
The Prescriptive requirements do,
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements o 150(j .
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written 'usti tcation and documentation and special verification.
NEW ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of § 151 2 does not apply to roof alterations.
Slab Edge (Perimeter) Insulation" O YES 0 NO
YES: In Climate Zone 16 in Component Packages D. R-7 insulation is required.
Heated Slab Insulation O YES 0 NO
YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation O YES 0 NO
YES: In Climate Zones 1. 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15. R-4 is required under component Package E.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 2009
-Prescriptive Certificate of Compliance: Residential CF -1R -AIT
Residential Alterations Page 5 of 5
Project Name: Climate Zone # # of Stories
k t
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required for this measure.
❑ YES O NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space. the ducts are to be sealed per §152(b)1Dii and the newly installed ducts are to be insulated per §151(f)10.
❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
13 YES 13 NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the
ducts are to be sealed per § 152(b)1 Di.
❑ YES ❑ NO YES: 1n Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced.(including the replacement of the air handbr,
outdoor condensing unit of a split.system, cooling or heating coil. or the furnace heat exchanger) the ducts are to be
sealed per § 152(b) I E.
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
0 EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Refrigerant Charge -Split System HERS verification is required for this measure.
E3 YES 13 NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump. cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per 152(b)1 F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of § 150 o do not apply to existing residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
O YES 0 NO YES: In Climate Zones 10 through 15. when the existing space -conditioning system (HVAC equipment and ducting) is
replaced, the airflow and fan watt draw shall be verified per §152(b)1Ci to meet the requirements of § 151 7B.
Documentation Author's Declaration Statement
1 • I certify that this Certificate of Compliance documentation is accurate and complete.
Name:. _ r~ Signature:
Compan Date:
Address:
if Applicable ❑ CEA or ❑ CEPE
(Certification #):
City/State/Zip,,
Phone;? & 0 -, 7 7 7
Responsible Building. Designer's Declaration Statement
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified an
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance confcrm
to the requirements of Title 24, Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms, worksheets. calculations, plans and specifications submitted to the enforcement
agency fora roval with this building permit application.
Name:
Signature:
Company:Date:
Address: �
License: 335—
City/State/Zip:
Phone:
0-7 7
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration A'umber: t Registration DaWTime:
2008 Residential Compliance Forms
HERS Provider:
August 2009
Bill #
City of La Quinic'.-
permit # P. 0. BOX 1504, 78-495 Calle Tampico
La Quinta, CA 92.2SJ - (760) 777-7012
11. Number:
Contra
so
elel) 1011C47
LIQ City Lic. fl:
Arch., F119r., Designer
State] ic. 1P P"Oje:cl tYpe ouc': New AddIn Alter Repair Demo
Name of Contact Per-,oll:
1E.Stimaled vilue of Project-
APPUGANT.- DO NOT WRITE EJELOW Tfft$ LINE
zz
!1 Strudural Calm 11 Reviewed, rotd v for Plon Check Deposit
lu
Platt Check B
it
Plumbing
Grant Deed
Plans pidmil up
DeVeloper Impact Fee
IN IIOUSr,.:-
it
School T,*O.es
.